Parents' socioeconomic factors related to high antibiotic prescribing in primary health care among children aged 0-6 years in the Capital Region of Denmark

Abstract

Objective: To investigate the distribution of antibiotic prescriptions in primary health care among children aged 0-6 years and its association with socioeconomic factors.

Design: A cross-sectional study describing antibiotic prescriptions and socioeconomic factors, using different population-based registers from Statistics Denmark.

Setting: Antibiotic prescriptions in 2012 from primary health care in the Capital Region of Denmark.

Subjects: The population of children aged 0-6 years (n = 139,398) in the Capital Region of Denmark.

Main outcome measures: High use of antibiotics identified by number of antibiotic prescriptions (≥ 3 prescriptions per year) and defined daily doses (DDD). A multinomial logistic regression analysis estimating the association between high antibiotic use and parents' education, employment status, income, child's sex, and ethnic background.

Results: Ten percent of children accounted for 25% of the total use DDD. There was a clear tendency that the risk for high antibiotic use increased as parental educational level decreased. The risk for high use was the highest among children of mothers and fathers with basic schooling ≤10 years (OR 1.60, 95% CI 1.29-1.98, and OR 1.60, 95% CI 1.34-1.91, respectively). Low income and unemployment were not associated with high antibiotic use.

Conclusion: Socioeconomic factors can only partially explain differences in antibiotic use. Further research is needed to clarify the unequal distribution of antibiotic prescribing and the association between high antibiotic use and low educational level. This would provide valuable information in the planning of strategies to promote rational use of antibiotics among children. KEY POINTS The Capital Region of Denmark has the highest rate of antibiotic prescribing in Denmark. Preschool children are among the age groups with the highest use. Ten percent of the children accounted for 25% of the total antibiotic use. Low parental educational level was associated with increased antibiotic use. Parents' income or employment status was not found to be associated with high antibiotic use.

Keywords: Antibiotics; Denmark; children; general practice; infection; primary health care.

Figure 1.

Number of prescriptions redeemed per child by age.

Figure 2.

Average number of prescriptions and average of DDD among children with ≥ 3 prescriptions.

Figure 3.

Lorenz curve of antibiotic use.